Percutaneous excimer laser coronary angioplasty of lesions not ideal for balloon angioplasty.

Cook, Stephen L.; Eigler, Neal; Shefer, Arie; Goldenberg, Tsvi; Forrester, James S.; Litvack, Frank

doi:10.1161/01.cir.84.2.632

Cited by 125 publications

(35 citation statements)

References 36 publications

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“…29,30 The problems associated with the vaporization of atheroma by lasers are thrombus formation, induction of spasm, vessel perforation, arterial aneurysm formation and restenosis. No complications such as perforation or occlusion by thrombus were seen in the present study of PDT using a YAG-OPO laser.…”

Section: Limitations Of the Present Studymentioning

confidence: 99%

Photodynamic Therapy of Atherosclerosis Using YAG-OPO Laser and Porfimer Sodium, and Comparison With Using Argon-Dye Laser

et al. 1999

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We performed photodynamic therapy (PDT) using the Yttrium Aluminium Garnet-Optical Parametric Oscillated (YAG-OPO) laser in cases of atherosclerosis, and examined its efficacy in vivo. We also performed PDT using an Argon-dye (Ar-dye) laser with the same output, and compared the efficacies. Following balloon denudation injury of the thoracoabdominal aorta, rabbits were raised on a cholesterol diet for 16 weeks, producing atheroma in that region. At 24 h following the administration of Photofrin 5 mg/kg, PDT was performed, and animals were sacrificed at 1 day, 1 week, and 2 weeks following the procedure to examine its efficacy. This was compared with the efficacy of PDT using the Ar-dye laser. Following PDT using a YAG-OPO laser, an increase in the vessel lumen was seen due to reduction of the hypertrophic intima and media, without the appearance of inflammatory cells. This result was seen more strongly in PDT using the pulse wave YAG-OPO laser than with the continuous wave Ar-dye laser, affecting not just the intima but also the media. These data demonstrated that PDT can effectively regress atherosclerotic lesions. (Jpn Circ J 1999; 63: 288 -295)

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Section: Limitations Of the Present Studymentioning

confidence: 99%

Photodynamic Therapy of Atherosclerosis Using YAG-OPO Laser and Porfimer Sodium, and Comparison With Using Argon-Dye Laser

et al. 1999

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“…The treatment of aortoostial lesions by conventional balloon angioplasty 175,176 and other devices, such as laser 177 or directional atherectomy, 178 has been limited by a low success rate and high incidence of restenosis. Coronary stenting is an attractive alternative for this subset of lesions because it provides the necessary scaffolding to support the artery.…”

Section: Ostial Lesionsmentioning

confidence: 99%

Limitations of coronary angiography compared with intravascular ultrasound: Implications for coronary interventions☆

Yamashita

Colombo

Tobis

1999

Progress in Cardiovascular Diseases

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The use of intravascular ultrasound catheters to produce images of lumen and plaque cross-sectional areas has had a profound effect on the practice of interventional cardiology. This imaging modality provides, for the first time, a low-power microscopic view of vascular anatomy within a living patient. This article will review some of the advantages of intravascular ultrasound imaging compared with angiography when used for diagnostic or interventional therapeutic procedures.Copyright 1999 by W.B. Saunders Company C oronary angiography is the primary mode of imaging coronary artery disease and guiding interventional procedures. Although coronary angiography was essential for the development of catheter-based coronary interventions, as the complexity of interventional cases increased, several limitations of angiography surfaced. Problems associated with coronary intervention, such as acute closure and restenosis, are related in part to properties of the lesion. Angiographic studies have reported inconsistent predictors of such adverse events. 1,2 One of the main reasons for this inconsistency is the limited power of angiography to delineate the complex anatomy of coronary atherosclerotic lesions. Intravascular ultrasound (IVUS) is a technique that provides two-dimensional, tomographic views of the coronary lumen and wall morphology in vivo, which has several advantages compared with angiography. 3 This article reviews the limitations of angiography and describes the information that IVUS imaging provides to complement angiography during diagnostic and interventional procedures. The ability of IVUS to evaluate lesion characteristics and dimensions alters therapeutic decisions and permits the operator to optimize each intervention. Lesion EvaluationEvaluation of coronary atherosclerotic lesions by angiography has been described by the joint American College of Cardiology/American Heart Association (ACC/AHA) committee. 4 This system delineates lesions by the degree of eccentricity and complexity. However, this analysis is limited by the ability of angiography to visualize only the lumen and not the atherosclerotic plaque itself. 91IVUS provides new insights for lesion evaluation because it produces a tomographic view of the artery and it is the only technique that permits visualization of the diseased artery wall in vivo. This capability is especially useful for diagnosing disease when vessels overlap or if there is a short stenosis. In addition, IVUS images are at a higher magnification than angiography, and its internal scale has been shown to be more accurate than angiographic assessment of plaque dimensions. Moreover, the ability of angiography to provide information on tissue characterization is limited. The following discussion will attempt to describe these differences between angiography and IVUS. Tomographic ImagingAn angiogram shows a longitudinal, two-dimensional view of the lumen of the vessel and does not directly show us the pathology, that is, the atherosclerotic plaque. If the plaque impinges on...

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“…However, in the following 100 cases, a "pulse and retreat" lasing technique was applied [81. With this technique the operator delivers only a small number of pulses, typically 262 Topaz et al [8][9][10][11][12], and then retracts the laser catheter back into the guiding catheter to permit unimpeded forward coronary blood flow. A 45-60 second pause is taken prior to the next lasing session to allow coronary relaxation.…”

Section: Laser Proceduresmentioning

confidence: 99%

“…The potential for excimer lasers to improve recanalization in lesions non-ideal for balloon angioplasty have been shown by several investigators [ 12,161. However, these lasers have certain limitations: A shallow penetration depth of only 50 microns El91 necessitates direct contact with the atherosclerotic plaque, and because their medium is gas, they need alignment, calibration, and medium replenishment.…”

Section: Rational For Laser Assisted Coronary Angioplastymentioning

confidence: 99%

Solid-state mid-infrared laser facilitated coronary angioplasty: Clinical and quantitative coronary angiographic results in 112 patients

et al. 1996

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Percutaneous excimer laser coronary angioplasty of lesions not ideal for balloon angioplasty.

Abstract: In our initial experience, excimer laser angioplasty was found to be acutely effective and safe therapy for lesions identified as not ideal for balloon angioplasty. This technique may provide a useful adjunct or alternative to balloon angioplasty in selected patients.

Cited by 125 publications

References 36 publications

Photodynamic Therapy of Atherosclerosis Using YAG-OPO Laser and Porfimer Sodium, and Comparison With Using Argon-Dye Laser

Photodynamic Therapy of Atherosclerosis Using YAG-OPO Laser and Porfimer Sodium, and Comparison With Using Argon-Dye Laser

Limitations of coronary angiography compared with intravascular ultrasound: Implications for coronary interventions☆

Solid-state mid-infrared laser facilitated coronary angioplasty: Clinical and quantitative coronary angiographic results in 112 patients

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